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The neuromuscular effects of mivacurium in adults with priming technique during nitrous oxide-fentanyl anesthesia: a
1Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Background:
We investigated the neuromuscular effects of equipotent dose (3 x ED90) of mivacurium either given as a single bolus or under the influence of priming technique, comparing with that of succinylcholine in adults undergoing elective surgery during nitrous oxide-narcotic anesthesia.
Methods:
Sixty ASA class I patients of either sex with age between 16 to 49 years were randomly assigned to 3 groups for a trial of mivacurium under nitrous oxide-narcotic anesthesia. Group I (non-priming group, n = 20) received mivacurium 0.25 mg/kg straight as a single intubating dose; Group II (priming group, n = 20) received an intubating dose of 0.225 mg/kg mivacurium which was preceded by 0.025 mg/kg 3 min earlier; and Group III received an intubating bolus of succinylcholine 1 mg/kg. Thenar electromyogram response to supramaximal train-of-four stimulation of the ulnar nerve at 12-s intervals was used to determine neuromuscular blockade. Blood pressure and heart rate were recorded before and at 1-min interval for 3 min after injection of drugs. Data were presented as mean +/- standard deviation. P value < 0.05 was considered statistically significant.
Results:
The onset time of mivacurium was accelerated by priming procedure in comparison with the nonpriming technique (2.0 min vs. 2.7 min), but it was much slower than that of succinylcholine (0.8 min). The priming procedure did not influence the duration of action or recovery. Side effects of mivacurium, such as cutaneous flushing and hypotension, were minimal at this dose in our patients.
Conclusions:
Priming technique (with 10% of the total dose as the priming dose, and 3 min as the priming interval) can hasten the onset of mivacurium in adults during nitrous oxide-narcotic anesthesia without influencing the duration of action and recovery time.
Insights
Priming with mivacurium (a neuromuscular blocker) significantly speeds up its onset of action when compared to a single bolus. This priming technique accelerates neuromuscular blockade without affecting recovery time during anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
- Neuromuscular blockade
Background:
- Investigated neuromuscular effects of mivacurium using priming vs. single bolus.
- Compared mivacurium with succinylcholine during nitrous oxide-narcotic anesthesia.
Purpose of the Study:
- To evaluate the impact of a priming technique on mivacurium's neuromuscular effects.
- To compare the onset and duration of action of primed mivacurium versus single-dose mivacurium and succinylcholine.
Main Methods:
- Sixty adult patients received either primed mivacurium, single-dose mivacurium, or succinylcholine.
- Neuromuscular blockade assessed via train-of-four stimulation and thenar electromyogram.
- Blood pressure and heart rate monitored post-injection.
Main Results:
- Priming accelerated mivacurium onset (2.0 min) compared to non-priming (2.7 min), but slower than succinylcholine (0.8 min).
- Priming did not alter the duration of action or recovery time.
- Mivacurium exhibited minimal side effects like flushing and hypotension.
Conclusions:
- Priming technique hastens mivacurium onset during anesthesia.
- Priming does not influence neuromuscular blockade duration or recovery.
- This method offers a way to improve mivacurium's efficacy in clinical settings.